Spurious Attention Heads in Vision Transformers: Mechanistic Identification of Annotation-Driven Bias in Medical Chest X-Ray Analysis

Abstract

Vision Transformers deployed in medical imaging exploit spurious correlations, yet the internal mechanisms remain unidentified and impossible to fix. We apply mechanistic interpretability to locate one such mechanism in ViT-Base 16: a single attention head (L8H10) that functions as a dedicated annotation-reader on chest X-rays, attending to corner text rather than lung pathology in 62% of 200 COVID-19 images. Causal validation via inpainting confirms annotation content rather than luminance or edge density drives the behaviour, increasing lung attention 1.52 times upon removal in affected images ($p{<}0.0001$). The finding replicates across NIH ChestX-ray14 (79%), DeiT-Base (88%), and ViT-Large 16 (80%), establishing spurious annotation-attending heads as a consistent property of ViT-family architectures across two datasets and three architectures. Full fine-tuning does not suppress the behaviour and may entrench it: 98.4% of spurious images remain spurious and the spurious rate rises marginally, as the shortcut is reinforced rather than removed. Critically, single-head ablation produces $p{=}0.340$ and multi-head ablation of all three identified carriers produces $p{=}0.532$, meaning a causally verified annotation-reading circuit is completely invisible to output-level evaluation. Mechanistic auditing finds what behavioural testing cannot.